15715: Bennett Fwd: AIDS - PBS Online NewsHour 27/05/03 (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: Nancy Bennett <nancymbennett@msn.com>


May 27, 2003


President Bush signed a bill today approving a five-year plan and $15
billion to fight AIDS worldwide. Fred de Sam Lazaro of Twin Cities Public
Television reports on the epidemic's toll in Haiti, one of the countries
that will benefit from the new plan.

FRED DE SAM LAZARO: For Haitians, the HIV epidemic has been long, painful,
and at times humiliating. At first, scientists thought the AIDS virus was
brought to the U.S. from here. Haitians were put on a watch list of four
"h"s, along with heroin users, hemophiliacs, and homosexuals. First Lady
Mildred Aristide lived in New York at the time.

MILDRED ARISTIDE: I was a college student in '83 or so, and we were going to
do a blood drive. And that was one of the questions asked by the Red Cross,
that was collecting blood: Whether I had recently visited Haiti or was of
Haitian origin. And so that has made it a special issue, because there had
been an attempt to label Haitians as being a cause of the disease.

FRED DE SAM LAZARO: Although unfairly stigmatized, Haiti does have a serious
AIDS problem, one that experts tie directly to its extreme poverty.
Two-thirds of Haitian adults are unemployed. Some 300,000 people-- about 5
percent of the population-- is infected with HIV, the AIDS virus. It's the
highest incidence in the western hemisphere. Still, Dr. Jean William Pape,
who returned to his native Haiti from New York 20 years ago, says the number
is well below what might be expected.

DR. JEAN WILLIAM PAPE: We have all the factors that would predispose this
country to have rates as high as 40 percent, 50 percent -- especially the
disease started here early; it spread very fast in the heterosexual
population. We have the highest rate of sexually transmitted diseases. We
have also... we're the poorest country with a very high rate of commercial
sex workers who are HIV-infected. If you put all this together, this is the
best recipe for an explosion of the HIV epidemic. Yet this has not occurred.

FRED DE SAM LAZARO: One reason it hasn't occurred is the work done in Dr.
Pape's Gheskio Center in the capital, Port au Prince, and a rural project
called Partners in Health. They've developed low-cost approaches to
prevention, testing, and care-- for example, controlling the incidence of
sexually transmitted diseases, which increase the risk of HIV Infection; and
for those already infected, treating complications like severe diarrhea.
Their success recently earned Haiti an award of up to $67 million over the
next five years from the U.N.'s global fund for AIDS, Malaria, and
tuberculosis. It will greatly expand the public health effort, and also make
available medicines including antiretroviral drugs. Haiti will be the first
developing country in which these so-called cocktail drugs will be somewhat
widely distributed. These medicines have allowed AIDS patients in rich
countries to lead almost normal lives. But they've long been considered too
expensive and not feasible in poor countries like Haiti. Dr. Paul Farmer has
long campaigned to change that thinking.

DR. PAUL FARMER: One of the biggest set of myths we're dealing about are
about therapy for HIV "HIV.. it can't be done in a placed like this; you
know, people don't have other rights; they don't have a concept of time;
they don't have wristwatches; the medications have to be refrigerated; it's
not cost effective." You know, it's not anything you would ever initiate in
a really poor country.

FRED DE SAM LAZARO: For 20 years, Dr. Farmer has divided his time between
Harvard Medical School and the Zanmi Lasante, or Partners in Health Project,
he founded in Haiti's remote central plateau. Since the late '90s, when
prices for some AIDS drugs to decline, partners in health has provided
antiviral medications to as many patients as it can. On a limited budget,
the drugs are funded mostly by private donations, and like all services
here, free to patients, most of whom could not afford them anyway.
41-year-old San Coeur Francois says he feels like a modern-day Lazarus. He
was brought in three years ago so close to death his family had purchased a
coffin. With drug therapy, he quickly recovered and has had almost no health
problems. Life is still a struggle. Francois cannot find employment. His
wife and two daughters moved temporarily to Port au Prince to find work. But
he's thankful for the chance to see his children grow up.

SAN COUER FRANCOIS ( Translated ): After god, I am most thankful to dr.
Paul. My weight was 95 pounds. I'm up to 142 now. The medications have done
so much for me. In Haiti, certainly those in port au prince knew these
medicines existed, but the price was so exaggerated. But here, patients
don't pay anything for the medications.

FRED DE SAM LAZARO: One unanticipated benefit of bringing antiretroviral
therapy to rural Haiti is that many more people are coming into clinics to
be tested for the AIDS virus. For the first time, doctors say, people have
been able to witness AIDS patients, people dying of AIDS, get better.

DOCTOR: Suddenly you have treatment, and a lot more people want to be
screened; you're going to get a lot more people who are negative, who are
sero- negative-- that is, they don't have HIV. And that's where you can
start making interventions to keep them from getting HIV.

FRED DE SAM LAZARO: There are other benefits as well, even for those who
don't receive the limited supply of drugs. They can be treated for
opportunistic infections, which kill thousands of AIDS patients in poor
countries. Tuberculosis is rampant in Haiti, for example, yet easily treated
for just a few cents per patient. 19-year-old Ketya, who is HIV-positive,
lost her mother and two siblings to tuberculosis. She now lives with her
father. Both have been treated for T.B. To ensure medicines get to patients
like Ketya, who are too poor and too far away from the clinic, volunteers
like Estany Deomille are recruited to visit patients every day. Some days a
doctor comes along, like David Walton, a recent Harvard Medical School
graduate. Ketya may need aids drugs later, he says, but for the moment, she
needs money. The small plot they farm cannot cover rent on their tiny home,
or the fees to help Ketya finish school. Partners in Health will provide the
money, an investment in AIDS prevention.

DR. DAVID WALTON: If she didn't had money to pay the house, and she didn't
go back to school, she'd have to do something to put food on the table and
to help her father, and that may entail maybe going to Port au Prince or
choosing a partner who has... who can give her some kind of financial
assistance.

FRED DE SAM LAZARO: Prostitution, in essence?

DR. DAVID WALTON: In a way, you can view it as such.

FRED DE SAM LAZARO: Paul Farmer called it survival sex yesterday.

DR. DAVID WALTON: That's perfect-- survival sex. She'd have to have sex with
this person to survive, and this person would likely have other partners,
and so she'd be exposed again. And then if he wasn't sick, she'd be exposing
him. So, I mean, this is the way in which we epidemiologically can kind of
step in and stop the progression and the spread of disease.

FRED DE SAM LAZARO: But Haiti has numerous other hurdles that hinder public
health. Poor roads means it takes too long to get medical care.

SPOKESMAN: Bonjour, Isaac.

FRED DE SAM LAZARO: Isaac was brought in too late, suffering from typhoid, a
common waterborne killer in a country where 80 percent lack safe drinking
water.

DOCTOR: I don't think he's going to make it.

FRED DE SAM LAZARO: Reporter: Despite all the hurdles, Dr. Pape says Haiti
has significantly curbed the incidence of HIV and related infectious
diseases. And those efforts will get a major boost with the global fund
grant. (Baby cries) But ironically, most of the money will go toward
uncovering yet more need. 25 new testing and counseling centers will be
opened across the country. Haiti's first lady, who oversees the government's
AIDS effort, says many more people will get HIV tests, and this could
greatly help in prevention.

MILDRED ARISTIDE: I think the most important tool that the global fund
project brings is this capacity, because then Haitians and women
specifically-- because the women, in my estimation, have been the most vocal
in wanting to know their status-- could be active agents of prevention,
information, education, passing that onto their children. But they need to
know, and right now, we don't have the capacity for folks to be able to be
tested.

FRED DE SAM LAZARO: Dr. Pape's goal is to reduce Haiti's HIV prevalence by
half. That won't eliminate the epidemic, but he's optimistic it will bring
it under control.

DR. JEAN WILLIAM PAPE: We used to say that only the optimist people have
stayed in Haiti. So you are talking to an optimist person.

FRED DE SAM LAZARO: Reporter: Experts share that optimism, and say it could
translate into hope for many developing countries ravaged by AIDS.



Copyright © 2003 MacNeil/Lehrer Productions. All Rights Reserved.

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